What is the recommended infusion rate for D5 (5% dextrose solution)?

Recommended Infusion Rate for D5 (5% Dextrose Solution)

The maximum recommended infusion rate for D5 (5% dextrose solution) is 0.5 g/kg of body weight per hour to avoid glycosuria, with approximately 95% of dextrose retained when infused at a rate of 0.8 g/kg/hour. 1

Calculation of Infusion Rate

To calculate the appropriate infusion rate for D5:

1. D5 contains 5 g of dextrose per 100 mL (50 g/L)
2. Maximum recommended rate: 0.5 g/kg/hour
3. For a 70 kg adult:
   • Maximum dextrose: 0.5 g/kg/hour × 70 kg = 35 g/hour
   • Maximum D5 volume: 35 g ÷ 50 g/L = 0.7 L/hour = 700 mL/hour

Clinical Considerations for Specific Situations

For Hypoglycemia Treatment:

• For insulin-induced hypoglycemia: 10-25 g of dextrose (200-500 mL of D5) is typically adequate 1
• Blood glucose should be monitored before and after administration
• In emergencies, dextrose should be administered promptly without waiting for test results

For Maintenance Fluids:

• For peripheral vein administration, infusion should be made slowly
• For central venous administration (such as TPN), D5 can be administered after admixture with amino acid solutions via an indwelling catheter positioned in a large central vein 1

For Special Populations:

• In pediatric patients with hyperkalemia, D10W (10% dextrose) can be administered at a rate of 100 mL/kg per 24 hours (approximately 7 mg/kg per minute) 2
• Older children may require substantially lower doses
• The rate should be titrated to achieve normoglycemia to prevent adverse CNS effects from hyperglycemia

Potential Adverse Effects and Monitoring

Risks of Excessive Infusion Rate:

• Glycosuria when exceeding 0.5 g/kg/hour 1
• Hyperglycemia (even 500 mL of D5 can cause significant transient hyperglycemia in non-diabetic patients) 3
• Potential worsening of cerebral edema with hypoosmolar solutions like D5W in patients with head trauma 4

Monitoring Requirements:

• Regular blood glucose monitoring
• Electrolyte monitoring, especially sodium levels
• Clinical evaluation for signs of fluid overload

Special Considerations

1. Head Trauma Patients: Avoid D5W as it may worsen cerebral edema 4
2. Stroke Patients: D5W should be avoided in acute ischemic stroke patients in the ED due to detrimental effects of glucose in acute brain injury 2
3. Hyponatremia: In patients with severe hyponatremia requiring CRRT, calculated amounts of D5W may be used prefilter to prevent overcorrection of sodium levels 5
4. Hyperkalemia Treatment: For patients with hyperkalemia and impaired renal function, a 250 mL D10 solution over two hours in addition to D50 bolus can help prevent hypoglycemia when insulin is administered 6

Practical Administration Tips

• Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration 1
• For patients requiring vasopressors, dextrose-containing solutions can be administered simultaneously through a separate line
• In patients with renal failure, careful monitoring is required as they may be more susceptible to fluid overload and electrolyte disturbances

Remember that the infusion rate should be adjusted based on the patient's clinical condition, with regular monitoring of glucose levels, electrolytes, and fluid balance to ensure optimal outcomes and prevent complications.